119 N. Vine St.
BUILDING PERMIT N(). . BLD2004-00270
TYPE OF PERMIT
BlockwallLColumns CITY.
DATE: 1/29/2004
JOB ADDRESS: 119 N VINE .ST
LEGAL DESCRIPTION: N TR 1389 LOT 9
BUILDING DIVISION
200 S. ANAHEIM BLVD:
(714) 765- 5153
. INSPECTION REQUEST LINE: .
(714) 765- 4626
CENSUS CODE: . 434
QUARTER SECTION: 93
APPLICANT: DANIEL VELASQUEZ
OWNER INFORMATION: CONTRACTOR INFORMJ.T!ON: ARCHITECT/ENGINEER INFORMATION:
Daniel Vela$qu~
119 N VineSt
Anaheim, CA 92805
JOB DESCRIPTION:Build 59 If of 6 It hi9h block wall per city standards, .
VALUATION: 1,416.00 PROCESSED BY: ODC
I .OWNER-BUILDE~"pECLARATION . I
I.hereby affi~m under penalty of perjury that I am exempt from the Gontracto_~-,3 Li-;ense Law for the following r~ason (Sec. 7031.5, Busiriessa.nd . .
Professions Code: any city or county which r:-equires a permit to construct; aII?"r, improve, del110lish or repair any structure,. prior to its issuance, also
requires the applicant for such permit to ,file a signed statement that he is,!ic(,nSed pursuant to the provisi"ons ofthe'Contracl:or's License Law (Chapter'
9}(conimencing with Section 7000 of Divisjon 3 of the Businessand Professi:~ns Code) or that he is exempt therefrom and the basis for. the alleged ,
c.i\.emption. My violation of SeCtion 7031.5 by any, applicant for a permit ~i;rJ~c;tS theappJicant to a civil penalty of not more than five hundred dolla~
~ner ~i property', or my ei11PI~y.ees with wages as their ~lepOri1/~p;atio~, will do the work~ 'ahd'the structure is no~ i~'tended or offered for
'sale (Sec. 7044 Business i:lnd Professions Code: The Contractor'S Lic~ns~ l~,03W doed not apply to an owner of property who .buildsorimproves
,;thereon, and w.t\Odoessudl work himself or herself or through his or her-cyF~ employ:p~. provided that such imp,,?vements are'not'intended or '.' .
offered for sale. If,. however, the'building or improvement is-sold wHh one ye~r of c..ompletioll. 'the pwner-build.er.will have the burden of proving that he
didnotbuUd'orimprovefurthepurposeofsale). .,. . '-",
D I; as the owner of the Property, am exdusivelycontradJng with licensed loontradorsto construct tht;l project (See. 7044 Busin~s.and Professions .
Code: Th~, Contractor's U~n'se Law does not apply to an owner of propert'ywho builds or improves thereon, and, who rontracts for such projects with
ontractor(s) Hcensed pursuant to the ContractQr's license Law). .,
a e em t nder Sec:, ' & .fqr thi reaso
t . Owner. .
WORKER'S CO P NSATION DECLARAT 4?
I hereby affirm under penalty of pe~Liry one of the, following' declarations:
D '.1 have and. will maintain a certificate of ronsei'lt to self-insure forworke..'~ compensation,
as provided for'by,Sedion 370Q,of theLaborCod~. for.the'performance ofth3work forwhicll
this permit is issueq.' : ' ,
D ,I have and will maintain worker's compenSation insurance, a~ required b> Sect~n-3700 ot"
the Labor Code, for the performance of the work for which this perr:nit is iSsu,~: My worker's.
Compensation insuranqe carrier and policy are:
Carrier:" . PoliCy Number.
LICENSED CONTRACTORS DECLARATION,
I hereby affirm under penalty of perjury that Jam"
licensed under provisions of chapter 9; (commencing
~with Section 7000) of Divsion 3. of the. Bus iness and
ProfessionS Cod~.' .
1/29/2004
Date:
.
Contractor
NUMBER
EXPIRATION DATE
This section need not be'completed if the pennit is for one,' hundreddc)Uai:S(S10C;: orl~_~.. .;0-
o lcertlfy that in ~e performance of the wc;>rk for whicl:1 this: permit is i~u~',:!,J~?ir npt'
employ any person in a ny man ner so as to become' subject to the work~"S:C~I~p~~s~tion _laws .
of Califomia, and agree that if I should becol1')esubj"ed to the worker'sc''')rr.p.,"'l)sa~on--/:-,', '
provisions of Section 3700 of the Labor . I Shall fi rthwith comply wittl~ths,e prov'fsions.
('
Date: 1/29/2004 Applicant:
WARNING:. FAILURE TOSECUREW KER'SCOMPEN ATI, C R^GE'IS ."',' .
UNLAWFUL, AND. SHALL SUBJECT AN EMPLOYER TO CRIMfl'!AL PE"iAcH,S:ANDPIVIL
FINES UPTO.ON.E HUN.DREDlHOUSAND DOLLARS ($100,000); IN ADl'lTIoN.TiJ THE
COST OF COMPENSATION, DAMAGES AS PROVIDED FOR (~{SECTlq, 370~:OFTHE .
LABOR CODE, INTEREST AND ATTORNEY'S FEES. . -', -, ...~.......<
., CONSTRUCTION LENDING AGENCY.
I hereby affirm under' p~nattyof perjury that there is a, construction lending zHencyfbrthe
performance ,of the wo~k for which this-permit is issued (Sec.309T:Civ.C): ~~
_~.."':i~(~:-.~~f::r;n~t1,:"~: .
. TYPE
,.:,.
coristrucion Types:
VN;. ,
Fire Spri'nktered?
NO
'" ",'
--,,::'--
,'certify that J have read this application and state that the above information is correcL'1
agree to complywit!1all city ordinances and state laws relating to building construction, and
'~ereby authorize're~resent!Ves ofthis.c:ity to enter upon the above mentioned property for
.insp~::.. .
. . Si9naa:~~nt Date: 1/29/2004
The permit shall expire by limitation and become null arid void if the building or
work has IKltpas!led fin;ll inspection 365 days from the date of permit issuance. A
new permit is required to commence or continue work.
Fees paid ,for Permit:
Total:
87.29.
INSPECTION RECORD
" INSPECTION DATE INSPECTOR
, ,
Temporary Power Pole'
, Plumbing (DrainlWlIste Pipe)
Electrical Ground Electrode/Ufer or ,/
SetbacklFormsrrrenches (Footings) rZ-I;-{) 1- I-
Do not install subfloOr or pour floor slab until the ,
following applicable items have been signed: ' '
Plumbing (Water Pipe.Sprinkler VlIlves)
Mechllniclll (Groundwork) " , ,
Electriclll (Underground Conduit) ,
Pre-slab (CompactionlMembr<me.Reinf.
Underpinning (Floor Joist/Girders)
Do not cover or concelll the work belOw until the
following applicable items ,have been signed:
1 st Floor Shellr , ,
'Fire$prinkJer (Rough) " ,
, 2nd Floor Shear ',' '., ',.
Roof (ShelllhlnglDiaphiagJTI/Frame)
, Masonry (RelnfJBond BeamlPre-Grout)
Rough Plumbing (Top Out)
Rough Mechanical, ,,',
I Rough Electrical (DrY Wall) ,
Rough Electrical
Framing '(Only aher Plbg.. Ele,.. Mech, and Fire)
Insullllion (SoundlEnergy) , '
Do not tape or plaster until the following applicable ,',
items have been signed: . - .
Drywall
Penetrations (Fire RlIled) Electrical , ,
, Penetrlllions (Fire RlIled) Mechanical
Penetrations (Fire RlIled) Plumbing ,
Interior Lath "
Exterior Lath
, GENERAL ITEMS,'
,Exterior Plaster (Brcjwn Coal)
T"Bar Electrical ,
T-BarMechanical
T -Bar Structural , ,
Sewer ,
Water Engineering Backfiow
Water SerVice ' '
FINAL INSPECTIONS
Electrical Final
Plumbing Final'
Mechanical Final
Gas Test
Engineering/Grading Final 765-5126
Fire Dept. Final 765,-4040
Water Engineering 765.5268
Sub List/Business License 765-51'9
Zoning 765.5139
Building Final (Last Inspection. Only
" After Above Complete)
PARTIAL INSPE
Buildinci Inspections
InspeCtor
, Date
Mechanical Inspections
Plumbina Insoections'
Electrical Inspections
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